Indigenous health in Latin America and the Caribbean.

This review is the second in a series on Indigenous health, covering different regions and issues. We look briefly at the current state of Indigenous health in Latin America and the Caribbean, a region with over 400 different indigenous groups and a total population of 45 to 48 million people. We describe the complex history and current reality of Indigenous peoples' situation within the American continent. We discuss the importance of Indigenous health systems and medicines, and look at changing political environments in the region. The paper concludes with a discussion of the changing political and legislative environment in Latin American countries.

Outcomes of pregnancy among women living in the proximity of oil fields in the Amazon basin of Ecuador.

Oil companies have released billions of gallons of untreated wastes and oil directly into the environment of the Ecuadorian Amazon. This cross-sectional study investigated the environmental conditions and reproductive health of women living in rural communities surrounded by oil fields in the Amazon basin and in unexposed communities. Water from local streams was analyzed for total petroleum hydrocarbons (TPH). The women, aged 17 to 45 years, had resided for at least three years in the study communities. Socioeconomic and reproductive histories of the last three pregnancies were obtained from interviews. Information from the questionnaire was available for 365 exposed and 283 non-exposed women. The study was conducted from November 1998 to April 1999. Streams of exposed communities had TPH concentrations above the allowable limit. After adjustment for potential confounders, the pregnancies of women in exposed communities were more likely to end in spontaneous abortion (OR: 2.47; 95% CI: 1.61-3.79; p < 0.01). No association was found between stillbirth and exposure. An environmental system to control and eliminate the sources of pollution in the area is needed.

La salud de mujeres que viven cerca de pozos y estaciones de petróleo en la Amazonía ecuatoriana / The health of women who live near oil wells and oil production stations in the Amazon region of Ecuador

OBJETIVOS: Investigar las condiciones ambientales y el estado de salud de las mujeres que viven en comunidades rurales rodeadas por pozos y estaciones de petróleo en la Amazonía del Ecuador. METODO: Se aplicó un diseño transversal comparativo, asignándose la exposición según la localización geográfica de las comunidades respecto a los pozos y estaciones de petróleo. Se analizaron muestras de agua de los ríos locales para determinar el contenido de hidrocarburos totales de petróleo y se proporcionó un cuestrionario estructurado a cada cabeza de familia. El estudio se localizó en comunidades campesinas del nordeste del Ecuador y duró desde noviembre de 1998 hasta abril de 1999. Se incluyenron en el estudio nueve comunidades en el área expuesta (368 participantes) y 14 en el área no expuesta (291 participantes). RESULTADOS: Los ríos de las comunidades expuestas presentaron niveles de contaminación muy superiores al límite aceptado para el uso humano. Se encontraron diferencias significativas en las razones de prevalencia de hongos en la piel (RP 1,37; IC951,01 a 1,86) en las dos semanas previas al estudio y de irritación de la nariz (RP 2,18; IC951,64 a 2,91) y garganta (RP 1,68; IC951,02 a 2,75) en los 12 meses aneriores. También se encontraron asociados con la exposición en las dos semanas previas el cansancio y "otros síntomas", y en los 12 meses anteriores, el dolor de cabeza, irritqación ocular, dolor de oídos, diarrea y gastritis. CONCLUSIONES: Los síntomas observados en las participantes de las comunidades expuestas concuerdan con los sítomas de toxicidad causados por el petróleo. Hay una necesidad urgente de establecer un adecuado programa de control y remediación ambiental que evite este innecesario e inaceptable reisgo para la salud de estas poblaciones

Objective. Investigate the environmental conditions in and the state of health of women who live in rural communities surrounded by oil wells and oil production stations in the Amazon region of Ecuador. Method. We used a comparative cross-sectional design, classifying exposure according to the location of the communities with respect to the oil wells and production stations. Water samples from the local rivers were analyzed to determine total petroleum hydrocarbons, and a structured questionnaire was used with the head of each family in the study. The study was performed in rural communities in northeastern Ecuador from November 1998 through April 1999. The study included 9 communities in the exposed area (368 participants) and 14 communities in the unexposed area (291 participants). Results. The rivers of the exposed communities showed contamination levels much above the limits acceptable for human use. Statistically significant differences between the exposed communities and the unexposed communities were found for the prevalence of skin fungi for the two weeks prior to the study (odds ratio (OR) = 1.37; 95% confidence interval (CI) = 1.01­1.86) as well as for nasal irritation (OR = 2.18, 95% CI = 1.64­2.91) and for throat irritation (OR = 1.68, 95% CI = 1.02­2.75) in the preceding 12 months. Also associated with exposure in the two preceding weeks were fatigue and the category of "other symptoms"; similarly associated with exposure in the preceding 12 months were headaches, eye irritation, earaches, diarrhea, and gastritis. Conclusions. The symptoms found among the participants in the exposed communities match the toxicity symptoms caused by oil. There is an urgent need to establish an adequate environmental control and remediation program in order to prevent unnecessary and unacceptable health hazards for these populations

Saúde e meio ambiente: uma análise de diferenciais intra-urbanos enfocando o Município de Säo Paulo, Brasil / Environment and health: an analysis of intra-urban differentials in the City of S. Paulo, Brazil

Apresenta projeto na área de diferenciais intra-urbanos de saúde no Município de Säo Paulo, SP, Brasil. Focaliza alguns aspectos do problema urbano na cidade, seguindo-se uma revisäo bibliográfica de trabalhos que abordam a questäo dos diferenciais geográficos na literatura paulista. Säo outras temáticas: a desagregaçäo geográfica do território a ser estudado e a metodologia de construçäo do índice de carência para definiçäo de zonas homogêneas no Município de Säo Paulo. Aponta qual seria a aplicaçäo dos resultados finais obtidos pelo projeto